Oral health-related quality of life among survivors of childhood cancer

Dental management of long-term childhood cancer survivors: a systematic review

PURPOSE

Critically review and summarise existing knowledge on prevalence of oral, dental, and craniofacial side-effects of antineoplastic treatment in childhood cancer survivors (CCS).

METHODS

A literature search was conducted for studies reporting on children aged 4-19 years treated for any type of malignancy up to the age of 15 years and for whom, at the time of the examination, more than 8 months have elapsed since the end of treatment. Data regarding dental late effects on teeth and craniofacial complex were collected and mean prevalence of each defect was reported.

RESULTS

From the 800 articles identified, 17 studies fulfilled inclusion criteria and were included. A total of 983 CCS were examined, with the total number of healthy controls being 1266 children. Haematological malignancy was the most prevalent diagnosis with the age at diagnosis ranging between 0-15 years. Multiple antineoplastic protocols were implemented with the elapsed time being 8 months up to 17 years. One-third of CCS experienced at least one late effect, with corresponding value for the control group being below 25%. Among the defects identified clinically, microdontia, hypodontia and enamel developmental defects were recorded in 1/4 of CCS. Impaired root growth and agenesis were the two defects mostly recorded radiographically. The effect on dental maturity and on salivary glands was unclear.

CONCLUSION

CCS are at risk of developing dental late effects because of their disease and its treatment and therefore, routine periodic examinations are essential to record their development and provide comprehensive oral healthcare.

Late Complications in Long-Term Childhood Cancer Survivors: What the Oral Health Professional Needs to Know

With diagnostic and therapeutic advances, over 80% of children diagnosed with cancer become long-term survivors. As the number of childhood cancer survivors (CCS) continues to increase, dental practitioners become more likely to have CCS among their patients. CCS may develop late complications from damage caused by their cancer treatment to endocrine, cardiovascular, musculoskeletal, and other organ systems. These complications may surface decades after the completion of treatment. Adverse outcomes of childhood cancer treatment frequently involve oral and craniofacial structures including the dentition. Tooth development, salivary gland function, craniofacial growth, and temporomandibular joint function may be disturbed, increasing oral health risks in these individuals. Moreover, CCS are at risk of developing subsequent malignancies, which may manifest in or near the oral cavity. It is important that dental practitioners are aware of the childhood cancer history of their patients and have knowledge of potential late complications. Therefore, this narrative review aims to inform dental practitioners of late oral complications of cancer treatment modalities commonly used in pediatric oncology. Furthermore, selected common non-oral late sequelae of cancer therapy that could have an impact on oral health and on delivering dental care will be discussed.

Oral health-related quality of life in Brazilian children, adolescents, and young adults undergoing cancer treatment

Introduction

Cancer is considered a major public health problem worldwide and may have an important impact on oral health-related quality of life (OHRQoL). Thus, the present study aimed to assess OHRQoL in Brazilian patients aged 3 to 21 years undergoing cancer treatment.

Materials and Methods

In total, 121 patients receiving cancer treatment and 363 healthy individuals (control group) were evaluated. OHRQoL was assessed using an age-specific questionnaire, that is, the Brazilian versions of the Early Childhood Oral Health Impact Scale (ECOHIS), the Child Perceptions Questionnaire (CPQ) 11-14-short version, the CPQ 8-10-short version, and the short-form of Oral Health Impact Profile Questionnaire-14 (OHIP-14).

Results

Individuals from the control group who were evaluated by the ECOHIS presented more impact on the OHRQoL regarding the psychological and family function score, as well as those evaluated by CPQ 8-10, who presented more impact in general. However, considering CPQ 11-14, cancer patients had their OHRQoL more affected, as shown in both the total questionnaire score and oral symptoms score.

Conclusion

Within the limitations of this Brazilian study, cancer treatment seems to be associated with decreased OHRQoL only in patients aged between 11 and 14 years. However, children without cancer aged between 8 and 10 years seem to experience worse OHRQoL.

Self-reported outcomes on oral health and oral health-related quality of life in long-term childhood cancer survivors-A DCCSS-LATER 2 Study

PURPOSE

The present study aimed to determine the prevalence of self-reported oral problems and the oral health-related quality of life (OHRQoL) in childhood cancer survivors (CCS).

METHODS

Patient and treatment characteristics of CCS have been collected in a cross-sectional study, part of the multidisciplinary DCCSS-LATER 2 Study. To assess self-reported oral health problems and dental problems, CCS filled out the 'Toegepast-Natuurwetenschappelijk Onderzoek' (TNO) oral health questionnaire. OHRQoL was assessed by the Dutch version of the Oral Health Impact Profile-14 (OHIP-14). Prevalences were compared with two comparison groups from the literature. Univariable and multivariable analyses were performed.

RESULTS

A total of 249 CCS participated in our study. The OHIP-14 total score had a mean value of 1.94 (sd 4.39), with a median score of 0 (range 0-29). The oral problems 'oral blisters/aphthae' (25.9%) and 'bad odor/halitosis' (23.3%) were significantly more often reported in CCS than in comparison groups (12% and 12%, respectively). The OHIP-14 score was significantly correlated with the number of self-reported oral health problems (r = .333, p<0.0005) and dental problems (r = .392, p <0.0005). In multivariable analysis, CCS with a shorter time since diagnosis (10-19 years vs. ≥30 years) had a 1.47-fold higher risk of ≥1 oral health problem.

CONCLUSION

Though the perceived oral health is relatively good, oral complications following childhood cancer treatment are prevalent in CCS. This underlines that attention to impaired oral health and awareness on this topic is mandatory and regular visits to the dentist should be a part of long-term follow-up care.

Qualidade de Vida e Saúde Bucal em Crianças submetidas à Terapia Antineoplásica

Introdução: O câncer e uma doença grave cujo protocolo de tratamento pode produzir severos efeitos colaterais de ordem psicossocial e física. Os principais efeitos do tratamento antineoplásico podem acometer a cavidade oral, especialmente em crianças, comprometendo a sua qualidade de vida e a do núcleo familiar. Objetivo: Identificar e descrever as lesões bucais relacionadas aos efeitos colaterais produzidos pelo tratamento antineoplásico e avaliar seu impacto sobre a qualidade de vida da criança e da sua família. Método: Estudo qualitativo e transversal, com a participação de 117 crianças pré-escolares atendidas em hospital de referência (Paraíba), por meio do questionário B-ECOHIS, de exames clínicos odontológicos e de prontuários médicos. O tratamento estatístico fundamentou-se na análise descritiva e regressão de Poisson com variância robusta no método Stepwise (p<0,05). Resultados: As manifestações mais observadas foram mucosite e xerostomia (66,7% e 54,7%, respectivamente). Relativo ao impacto na qualidade de vida da criança, o domínio de maior média foi limitação funcional 3,0 (±1,8) e, na família, função familiar 1,0 (±1,0). Conclusão: O impacto na qualidade de vida das crianças se revelou fraco e, no núcleo familiar, não foi significativo.

Oral health-related quality of life among pediatric liver transplant candidates

To assess the impact of oral conditions on the oral health-related quality of life (OHRQoL) of pediatric liver transplant candidates. This cross-sectional study included 60 children aged 13 to 48 months who were liver transplant candidates that attended the AC Camargo Cancer Center, São Paulo, Brazil. On the day of oral examinations, the children's mothers were invited to answer two questionnaires; one related to children's OHRQoL using the B-ECOHIS and another related to socioeconomic/demographic characteristics. Thereafter, a single, adequately trained dentist carried out children's oral examinations for gingival inflammation (Silness-Löe index), dental plaque (Green-Vermillion Simplified index), dental caries (dmft index), developmental defects of enamel (DDE index), tooth discoloration, oral mucosal/lip alterations. The data collected also included socioeconomic/demographic characteristics and liver disease. The adjusted Poisson regression model was used to associate children's socioeconomic/demographic characteristics and clinical conditions to the outcome. The adjusted regression model showed that children with untreated caries lesions (RR = 3.35, p < 0.0001) and tooth discoloration (RR = 1.74, p = 0.04) had poorer total B-ECOHIS scores. Dental discoloration and untreated caries lesions had a negative impact on the OHRQoL in pediatric liver transplant candidates.

Oral health-related quality of life in children using the child perception questionnaire CPQ11-14: a review

OBJECTIVES

The Child Perceptions Questionnaire 11-14 (CPQ11-14) is the most common and effective indicator of paediatric oral health-related quality of life. The aim of this review was to verify if CPQ11-14 can be considered a valid instrument for assessing the impact of oral health on the quality of life of adolescents for the paediatric population aged between 11 and 14 years old and which dental conditions mainly affect it.

STUDY DESIGN

A literature research from Pubmed Medline database was adopted to identify the eligible studies among the published articles related to CPQ 11-14 using keyword search strategy. From 170 initial articles, a total of 128 articles were included for the full text reading.

RESULTS

Conditions that mainly interest the oral health-related quality of life are untreated dental caries, dental trauma, increased dental protrusion, wearing orthodontic appliances, and severe periodontal disease.

CONCLUSION

CPQ 11-14 seems to be a solid and valid indicator to measure oral health-related quality of life, because it has been widely tested and validated in several states including developed, developing and underdeveloped countries.

Late effects of multiagent chemotherapy on salivary secretion in children cancer survivors

OBJECTIVE

The aim of this study was to investigate the later oral consequences of chemotherapy on the oral health of children with emphasis on the cariological status and the major and minor salivary gland function.

METHOD

Thirty-eight 12-year-old children (mean age 12.3 ± 0.58 years) who underwent chemotherapy were evaluated after 5 years of treatment. Forty age- and sex-matched healthy children with similar socioeconomic backgrounds served as controls. Subjects' cariological status was explained by the number of decayed, filled, missing permanent teeth (DMF-T), and unstimulated and stimulated whole saliva flow rates were measured by the spitting method. Palatal saliva flow rate using a Periotron meter (Oraflow Inc., Plainview, NY) and salivary buffer capacity using CRT buffer (Ivoclar Vivadent AG, Schaan, Lichtenstein) were also investigated.

RESULTS

Children who underwent chemotherapy had significantly more decayed teeth than healthy controls (3.97 ± 3.58 vs 0.84 ± 1.75, respectively, p < 0.001). Recipients of chemotherapy had significantly lower stimulated whole saliva flow rate (0.84 ± 0.35 vs 1.13 ± 0.46 ml/min, p < 0.05) compared to the controls. Palatal saliva flow rate was at the same time significantly higher in the test group compared to the controls (1.64 ± 0.87 vs 0.46 ± 0.32 ml/min/cm(2), respectively, p < 0.001). High levels of buffer capacity of the saliva could be detected in a significantly higher prevalence in the patient group compared to the controls (high: 81.6% vs 40%).

CONCLUSIONS

According to these results, chemotherapy in children might result in a decreased stimulated whole saliva flow rate, hyposalivation, and, consequently, increased caries risk. Although these processes might be compensated to a limited extend by the increased minor saliva flow rate, resulting in a higher buffer capacity, nutrition and oral hygiene control of children obtaining cancer therapy is essential in the preservation of the oral tissues.

Assessment of the quality of measures of child oral health-related quality of life

Background

Several measures of oral health-related quality of life have been developed for children. The most frequently used are the Child Perceptions Questionnaire (CPQ), the Child Oral Impacts on Daily Performances (C-OIDP) and the Child Oral Health Impact Profile (COHIP). The aim of this study was to assess the methodological quality of the development and testing of these three measures.

Methods

A systematic search strategy was used to identify eligible studies published up to December 2012, using both MEDLINE and Web of Science. Titles and abstracts were read independently by two investigators and full papers retrieved where the inclusion criteria were met. Data were extracted by two teams of two investigators using a piloted protocol. The data were used to describe the development of the measures and their use against existing criteria. The methodological quality and measurement properties of the measures were assessed using standards proposed by the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) group.

Results

The search strategy yielded 653 papers, of which 417 were duplicates. Following analysis of the abstracts, 119 papers met the inclusion criteria. The majority of papers reported cross-sectional studies (n = 117) with three of longitudinal design. Fifteen studies which had used the original version of the measures in their original language were included in the COSMIN analysis. The most frequently used measure was the CPQ. Reliability and construct validity appear to be adequate for all three measures. Children were not fully involved in item generation which may compromise their content validity. Internal consistency was measured using classic test theory with no evidence of modern psychometric techniques being used to test unidimensionality of the measures included in the COSMIN analysis.

Conclusion

The three measures evaluated appear to be able to discriminate between groups. CPQ has been most widely tested and several versions are available. COHIP employed a rigorous development strategy but has been tested in fewer populations. C-OIDP is shorter and has been used successfully in epidemiological studies. Further testing using modern psychometric techniques such as item response theory is recommended. Future developments should also focus on the development of measures which can evaluate longitudinal change.

Psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) for caregivers of children with gastrostomy tube nutritional support

BACKGROUND

To analyse the psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) in parents/caregivers of children with home enteral nutrition (HEN) by gastrostomy tube (GT).

METHODS

Eighty-six caregivers (mothers) of paediatric patients with HEN by GT were recruited. Patients suffered from neurological disease (61.6%) and other chronic diseases. The SAGA-8 scale, a structured questionnaire to explore satisfaction with HEN by GT, and the Caregiver Burden Inventory (Zarit) were completed. The discriminating power of each of the SAGA-8 items, internal consistency and external validity were evaluated. An exploratory factor analysis and Kaiser-Meyer-Olkin (KMO) was performed as well.

RESULTS

Eighty-four percent of the families expressed high satisfaction with GT feeding. All eight items of SAGA-8 gave additional information. The exploratory factor analysis revealed that a significant part of the items' variability could be explained by two independent factors: Factor 1 (direct benefit), which compiled the variables related to the perception of children's overall improvement by GT feeding; Factor 2 (indirect benefit), which grouped the variables related to a decrease in respiratory infections, feeding time and institutional support. Results from KMO (0.628) indicated the high adequacy of the items assessed in the factorial analysis. Moreover, the questionnaire presented high internal consistency (0.76), and the external validation analysis confirmed the correlation between SAGA-8 and Zarit, thereby emphasising the approptiate use of the SAGA-8 to detect carers' satisfaction.

CONCLUSIONS

The SAGA-8 questionnaire has a high discriminatory power to assess the degree of satisfaction experienced by parents/caregivers of children with HEN by GT and, subsequently, the patients' wellbeing.